Can the new CPT code G2211, “visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established),” which went into effect on January 1, 2024, be used in GI practices?
ASGE members may submit coding inquiries electronically to codingquestions@asge.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
Can the new CPT code G2211, "visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)," which went into effect on January 1, 2024, be used in GI practices?
Answer
Yes, this can be used in GI practices when managing patients with serious chronic conditions, such as Crohn's disease and ulcerative colitis, and chronic liver conditions. This is all dependent upon your provider's documentation in the assessment and plan. Here are some tidbits and resources available on the Centers for Medicare and Medicaid Services website:
- Should be used by medical professionals, regardless of specialty, with E/M visits of any level for care serving as the continuing focal point for all needed health care services or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition.
- Is reported with associated CPT codes 99202-99205 and 99211-99215.
- G2211 is awarded 0.49 RVUs in the current Medicare fee schedule.
- Is not payable when the E/M visit is reported with modifier -25. Claims will be denied if reported on the same date of service for the same patient by the same provider.
- https://www.cms.gov
- https://med.noridianmedicare.com
- https://www.palmettogba.com
- https://www.novitas-solutions.com
Question #2
If a patient has been diagnosed with ulcerative colitis, they won't ever be eligible for a screening, correct?
Answer
A patient with inflammatory bowel disease can still be eligible for a screening as long as the documentation states that the patient presents for a screening and is asymptomatic and the doctor does not take random biopsy specimens to assess disease. If abnormalities or polyps are found and a biopsy is performed, or the abnormalities or polyps are removed, then this would be screening turned diagnostic.